Pre-Gait Activities Flashcards
(32 cards)
1
Q
What is involved in prosthetic training
A
- Pre-prosthetic training and preparation
- Care of prosthetic componentes and residual limb
- Donning/doffing of prostheses
- Assessment of prosthetic fit
- Pre-gait activities and training
- Gait training/assessment and environmental negotiation
- Gait dysfunction/patterns
- Outcome measurement
2
Q
What is involved with prosthetic preparation
A
- Protect incision/residual limb integrity
- Regular skin checks
- Shaping of the residual limb
- Scar mobilization
3
Q
What are the components of a prostheses that requires care
A
- Linear/nylon sheath
- Socks
- Prosthesis itself
4
Q
4 steps of component care
A
- Hand wash with mild soap and water
- Rotate daily and allow to dry overnight
- Remove any debris
- Check for uneven areas/holes and replace when worn
5
Q
Describe prosthetic socks
A
- Different thicknesses/ ply
- Most common is 1, 3, and 5 ply
- You have to add them together to get the total ply
- Goal is to wear the least number of socks to get the correct ply.
- Educate the patient to always carry multiple socks and they will need to adjust ply during the day.
6
Q
Prosthetic donning
A
- Safest if performed initially in sitting
- Most patients will need to stand to get all the way down into the socket but want to don most things in seated
- Start with liner -> don correct number of socks for a snug fit but able to drop all the way into the prosthetic
- Don thickest sock first progressing to thinnest — its easier to adjust ply later
7
Q
Trans-tibial donning
A
- Angle of prosthesis with knee flexed to 30-45 deg
- Align patella with patellar cut out
- Gently push down on knee or slide down into socket to engage suspension method (shuttle lock, suction, vacuum)
- Stand and weight shift to slide down to final resting position
8
Q
Trans-femoral donning
A
- Don in sitting if possible
- Slide into socket as far as possible
- Attach socket to limb via suspension mechanism (suction, vacuum, strap)
- Stand to lock into prosthesis/get to final resting position — requires good dynamic balance
- Lock knee in standing prior to weight shifting.
9
Q
How do you assess a transtibial prosthetic fit
A
- Assess in standing
1. Patella lined up with cut out
2. Supracondylar ridges over femoral condyles
3. Patellar tendon just above patellar bar
4. Tight fit between socket and residual limb
5. Not bottoming out
10
Q
How do you assess transfemoral prosthetic fit
A
- Assess in standing
1. Bend forward to assess ischial tuberosity
2. Abduct prosthesis to palpate public ramus.
11
Q
What are other prosthetic fitting observations
A
- Pelvic alignment — want symmetry of iliac crests and ASIS
- TF socket — flex, add, wall height
- TT socket — IR/ER, valgus/varum, supracondylar trims
- Feet — prosthetic foot flat on floor, slight toe out, PF/DF
12
Q
Steps for doffing prosthesis
A
- Performed in sitting
- Disengage locking/suspension mechanism
- Slide off prosthesis
- Take off socks/sleeve
- Skin inspection (can use handheld mirror)
13
Q
General skin inspection tips
A
- Total surface bearing and transfemoral = look for general redness and reports of discomfort, should not be over areas of bone prominences
- Note amount of sweating or any rashes
- Redness should dissipate within 20-30 minutes
- Educate patient on expected areas of redness
- Put compression method back on or rewrap
14
Q
Transtibial pressure tolerance areas
A
- Patellar tendon
- Supracondylar areas
- Tibial flares
- Hamstring muscle/posterior residual limb
15
Q
Transtibial pressure INtolerance areas
A
- Femoral condyles
- Patella
- Tibial tub
- Tibial crest
- Fibular head
- Anterior/distal ends of tibia and fibula/incision line
16
Q
Transfemoral pressure tolerance areas
A
- Ischial tub
- Around the middle of the residual limb
- Distal end of the residual limb
17
Q
Transfemoral pressure INtolerance areas
A
- Greater trochanter
- Pubic ramus
- ASIS
- Adductor tendon
- Distal femur
- Pubic tubercle
- Incision
18
Q
Other skin inspection tips
A
- Unexpected areas of discomfort or redness
- Compare to pressure tolerant areas
- Consider patient causes and donning techniques
- Look at prosthetic and LE alignment
19
Q
Prosthesis wear schedule
A
- Start 1-2 hour wearing with weight bearing no more than 20-30 minutes.
- Then 1-2 hours off and repeat (use shrinkers when not wearing it)
- Typical progression 30-60 minutes increase every 2-3 days
- Progression depends on tolerance and how quickly redness dissipates
- Progress activity level and wear time separately
20
Q
Patients may have difficulty achieving weight bearing through prosthesis during sit to stand if…
A
- TTprosthesis knee cannot flex far enough for the foot to be flat on floor
- TF prosthetic knee cannot provide knee extension force, must be locked for stability
21
Q
What are the goals of pre-gait training in this population
A
- Increase weight t bearing through the prosthesis
- Decrease deviations
- Increased patient confidence and kinesthetic awareness
- Learn how to control the components
22
Q
Stand to sit considerations for transfemoral patietns
A
They may have to unlock the knee prior to sitting
- method of stand to sit depends on the type of knee joint they have
23
Q
Why is it important to normalize weight bearing with a prosthetic
A
- Normalize gait patterns
- Increased proprioception through prosthesis
- Protection of the sound limb
- Fall prevention
- Prevention of lumbar dysfunction (pelvic rotation is big weakness for these patients)
24
Q
Examples of weight bearing exercises
A
- Static balance with intact foot on step — can progress with a foam pad
- Intact foot taps on step
- Weight shift COM (usually belly button) over prosthesis
- Marching — go from a firm surface to more compliant
- Single limb stance
25
Examples of balance exercises for pre-gait training
- Apply perturbations
- Weight shifts in all planes
- Staggered stance
- Reaching out of base of support
26
Examples of provide proprioceptive input exercises
- Hit different parts of prosthetic foot with reflex hammer (they will feel it higher up. Their proprioceptive input is at the end of their residual limb)
- weight bearing/shifting — with focused attention
27
What else do you have to consider with pre-gait training
- Determine the amount of UE support needed
- B vs. U vs. No UE
- contralateral vs. Ipsilateral support
28
What should be in the home program
1. Criteria for using prosthesis at home.
2. Independent donning/doffing without or with caregiver assist
3. Ability to perform skin checks and know when not to wear prosthesis
4. Understanding pressure tolerant areas
5. Safely able to perform mobility and/or ability to instruct a caregiver on how to provide assistance.
6. Exercises and activities that facilitate wear bearing and gait mechanics.
7. Increase use of prosthesis during ADLs and IADLs
29
What should we include with flexibility with HEP
- Continue to manage/prevent contractures
- specifically address: hip flexors, abductors, ER, and hamstrings
30
What strengthening do you include in HEP
- Promote hip stability
- Hip abductors and extensors
- Core stability
- Open chain stuff with and without prosthesis
- Closed chain stuff — more functional and helps with increasing proprioceptive input
31
Specific strengthening for TF vs. TT
TF - hip flexors to improve swing-through, hip extensors for stance stability
TT - promote knee stability esp. quads and hamstrings
32
What balance stuff for HEP
1. Improves confidence in prosthesis
2. Helps to normalize gait pattern and decrease dependence on an AD
3. Stepping reactions in all directions
4. Single limb and tandem activities
5. Compliant surfaces depending on foot component
6. Determine amount of UE support needed
